Anterior Only Surgical Management Of Tuberculosis Of The Adult Thoracic Spine

Aim:

Historically, anterior decompression followed by posterior fusion has been the surgical management of choice in spinal tuberculosis. Due to theatre time being at a premium, we have evolved to performing anterior only debridement, allograft strut reconstruction and instrumentation for tuberculosis in the adult thoracic spine.

The aim of this study is to review the safety and the efficacy of this treatment.

Methods:

Twenty-eight adult thoracic tuberculosis patients were identified where anterior only surgery had been performed. These were all in the mid-thoracic spine as circumferential surgery is still favoured in thoracolumbar disease. The surgery was performed by a single surgeon at a tertiary hospital.

Following transthoracic aggressive debridement, allograft humeral shafts were cut to size and inserted under compression and the spines instrumented with the use of screw-rod constructs into the body above and below.

A retrospective review of clinical notes and radiological studies was performed.

Results:

Twenty-seven of the patients presented with altered neurology; 2 had only sensory changes while 25 presented with paraparesis; 22 of these patients were unable to walk.

The average surgical time was 2 hours 20 minutes with a median blood loss of 726 ml. The majority of patients had 2 vertebral bodies involved and required an average of a 4 body fusion.

Surgical complications included inadvertent opening of the diaphragm in 1 patient and 1 patient deteriorated neurologically post operatively.

21 of 28 patients recovered to independent mobility at their latest follow-up appointment. 1 patient showed no recovery, 3 had some motor recovery that was not useful, 1 had some sensory but no motor recovery.

16 of 28 patients have documented bony fusion with no evidence of instrumentation failure in any patients.

Conclusion:

Anterior only debridement, allograft strut reconstruction and instrumented fusion for the treatment of thoracic spinal tuberculosis is a safe and effective alternative to circumferential surgery in the adult patient.